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Symptomatic huge diaphragmatic hernia
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  1. Valerio Pontecorvi,
  2. Lorenzo Dioscoridi,
  3. Aurora Giannetti and
  4. Massimiliano Mutignani
  1. Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
  1. Correspondence to Dr Lorenzo Dioscoridi, dioscoridi.lorenzo{at}virgilio.it

http://dx.doi.org/10.1136/bcr-2019-229286

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    Description

    The present images refer to a 54-year-old patient with cholangitis due to biliary stones.

    He underwent distal oesophagectomy and total gastrectomy with Roux-en-Y reconstruction for a tumour of oesophageal-gastric junction 5 years before.

    An endoscopic retrograde cholangiopancreatography was attempted but it failed because of the impossibility to access the duodenal pouch due to abnormal rounds of the scope caused by a suspected bowel’s hernia in the thorax.

    A CT scan (figures 1 and 2) was then performed, and it showed the presence, in retrocardiac position, of a massive diaphragmatic herniation of the small bowel,1 2 along with mesenteric vessels, which reached the apex of the left hemithorax.

    Figure 1
    Figure 1

    CT scan (coronal view) showing the herniation of the small bowel occupying almost all of the left hemithorax.

    Figure 2
    Figure 2

    CT scan (axial view) with the evidence of the large diaphragmatic defect along with the mesenteric vessels.

    This condition is completely asymptomatic, and the patient is now scheduled for preoperative evaluation.

    Patient’s perspective

    In the end, I was more worried for the hernia than for the biliary stones. It scared me a lot. I would like to thank the Niguarda Hospital for taking care of me.

    Learning points

    • Incidental huge diaphragmatic hernias in adults are rare occurrences.

    • Huge diaphragmatic hernia is a rare cause of endoscopic retrograde cholangiopancreatography failure.

    References

    1. ↵
      2. Chaturvedi A ,
      3. Rajiah P ,
      4. Croake A , et al
      . Imaging of thoracic hernias: types and complications. Insights Imaging 2018;9:989–1005.doi:10.1007/s13244-018-0670-x
      OpenUrl
    2. ↵
      2. Sandstrom CK ,
      3. Stern EJ
      . Diaphragmatic hernias: a spectrum of radiographic appearances. Curr Probl Diagn Radiol 2011;40:95–115.doi:10.1067/j.cpradiol.2009.11.001
      OpenUrlCrossRefPubMed

    Footnotes

    • Contributors VP wrote the paper and found the images. LD had the idea of the case report and revised the paper. AG revised the images and wrote the key highlights. MM revised the workpiece.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.